THE “SPIRIT OF DUNKIRK” AND THE ENGLISH NHS

HEORY, HISTORY AND EVIDENCES

Abstract

The aim of this paper is to analyze the specificities of the National Health Service (NHS), the public, universal and, in a great extent, free healthcare system of England, from a theoretical, historical and empirical approach. It is argued that a more sophisticated social protection systems in which the NHS is included tend to be more likely and more resilient in heterogeneous societies, since in these cases, their benefits and costs are distributed in a less asymmetrically way among the different groups that compose it. Since this is not the case of the English society, its emergence was only possible in exceptional historical circumstances, in which prevailed the ‘spirit of Dunkirk’. As soon as they were gone, the reform process of the system begun. The reforms carried out since then have not been able to greatly improve the system’s performance, to the extent that the supply was not able to meet properly the demand for healthcare services. This became even more evident after the outbreak of the international crisis in 2008, in general, and in Europe, in particular, when the new coalition government adopted strict austerity measures that led to the reduction of resources available for new investments in staff and infrastructure. The analysis of the NHS experience indicates that the construction of more sophisticated social protection systems in more heterogeneous societies is highly unlikely in the absence of exceptional historical circumstances.